Most concerns about the Federal Budget’s imposition of a $7 GP co-payment have been around its impact on the health of vulnerable individuals and families. Below Catherine Bateman-Steel and Leena Gupta discuss the risks for the protection of public health, particularly when we need to respond to outbreaks of communicable diseases like measles and meningococcal disease.
They ask what happens when, to protect the whole population, we need people to engage with their health provider for the sake of others and not for their own health – and then ask them to pay?
Catherine Bateman-Steel and Leena Gupta write:
GP co-payments and communicable disease control – disintegrated systems are vulnerable systems
GP co-payments threaten engagement with health services. Whilst health professionals focus on finding ways to increase integration between communities and health systems, the Government’s proposed $7 payment to see a GP threatens to undermine these efforts.
Stephen Leeder has commented that the measures proposed are an issue of ‘social fabric’ as well as economics1. This social fabric extends to the health system.
Health cannot be promoted or protected when the people it serves are not well integrated into the system, accessing treatment when necessary and engaging in preventative activities. As frontline public health physicians we have serious concerns as to how these financial changes will affect our capacity to combat infectious disease in the community.
In our work, we need to rapidly identify health threats that arise from communicable disease or from the environments in which populations live and work. We constantly rely on the networks we have developed with GPs and Emergency Departments that link us to people at risk in the community. Without these networks we cannot reach communities.
An important example is measles. Measles is highly infectious and can have serious consequences in the unvaccinated. If notified of a case we need to quickly identify unvaccinated or vulnerable contacts and make sure they are provided with vaccination or other treatment for protection. GPs and emergency departments are absolutely vital to tracing and treating these individuals. We may need to ask a large number of people to engage with their GP to receive treatment and prevent spread. For example in 2011 when there were 26 confirmed cases in Western Sydney, follow up of 1,395 contacts was required, of which nearly 200 required some form of treatment2. Many of these people would have gone through their GPs.
It is even more complex for diseases like meningococcal disease. This disease can progress very rapidly and cause meningitis and death, but the organism responsible can be carried by people who have no symptoms.
If we are to limit spread of the disease we may need to send a potentially large number of well, unaffected people to get antibiotics from their GP to prevent spread of the organism. They are accessing care not for their own immediate health benefit but with the hope that if they are a carrier we prevent them spreading disease to others.
If GP co-payments are put in place, many of these interactions will attract a cost. Every vaccination offered, every antibiotic course requested, every stool sample to investigate food outbreaks, every blood test to confirm infection will attract a cost. It will be extremely unlikely that contacts from disadvantaged backgrounds can pay for a service, and blood tests, and medications, which they do not need for their own immediate health. In protecting the whole population we need people to engage with their health provider for the sake of others and not for their own health: asking them to pay for this will be a potential barrier to preventing disease spread.
GP co-payments are a financial barrier to GP-patient interaction and likely to cause disintegration of the networks that health protection, and much of the health system generally, relies upon.
Studies have indicated that 16 per cent of people in Australia already delay accessing GP services due to a fear of cost3; this number will only increase. Lack of trust and misconceptions of health providers already present challenges in building integrated health networks. A financial disincentive will add an extra level of challenge in reaching the most disadvantaged populations, which are also the communities most often affected by communicable disease.
A well-functioning, efficient, health system that not only responds to illness but can identify and mitigate against threats to health in a timely, and cost-effective manner needs a well-integrated system, a tightly woven fabric in which members of the public and health professionals are closely connected. The co-payment is a measure that goes well beyond sharing the cost of care with the individuals that access care. It is a threat to the integration that allows a health system to work efficiently to protect the health of the public.
Catherine Bateman-Steel is the Public Health Registrar in the Sydney Local Health District and Adjunct Lecturer at the School of Social Sciences, University of New South Wales. Leena Gupta is Director of Public Health at the Sydney Local Health District and Adjunct Professor in the School of Medicine in Sydney at the University of Notre Dame Australia.
1. Leeder, S in “Bill Shorten’s budget reply: experts react. The Conversation 15 May 2014 http://theconversation.com/bill-shortens-budget-reply-experts-react-26755 (accessed May 2014).
2. Flego, Kl. Et al. Impacts of a measles outbreak in Western Sydney on public health resources, 2013. Communicable Diseases Intelligence Quarterly Report, 37 (3), E240-E245. http://ro.uow.edu.au/smhpapers/1465/ (accessed May 2014).
3. Doggett J. Empty pockets: why co-payments are not the solution. Canberra: Consumers Health Forum of Australia, 2014. https://www.chf.org.au/pdfs/chf/Empty-Pockets_Why-copayments-are-not-the-solution_Final-OOP-report.pdf (accessed May 2014).